Inside a psychiatric ward

Rather than working on strengthening these patients’ sense of self, this psychiatric hospital seemed to rob them of what little they had left. Photo: Getty

‘Everybody hates being here. People talk about killing themselves, not because they want to die but because they want to get out of the hospital’, said my friend Julie.

It’s not the sentiments you’d ordinarily expect from a hospital patient. But then this is no ordinary hospital. It’s a psychiatric hospital in inner-city Melbourne. Patients spend around $9500 per week to be there but it ain’t no Golden Door health retreat.

Many are there against their own will. My friend Julie is one of the lucky ones. She admitted herself in order to come off anti-depressants and so was able to leave (although even then, she had to insist on leaving). Detoxing from anti-depressants is no picnic. In fact some people find the withdrawal so difficult they are unable to cease their medication.

Julie suffered from postnatal depression and anxiety after the birth of her son four years ago, but is otherwise a fully functioning mother, wife, university lecturer and professional painter.

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If your idea of psychiatric wards comes from One Flew Over the Cuckoo’s Nest, then you’re not wide of the mark.

Many of the patients — most of who were women — looked scared and unsure. They either stared blankly into space or were looking around skittishly like kittens that have been kicked.

And it’s not surprising. Many of the patients are infantilised. During one of my visits, a nurse commented on a landscape Julie had painted in an art therapy class.

‘Oh you’ve got a little bit of artistic flair, haven’t you?’ she said. Aside from the fact that Julie is a professional artist, the nurse’s tone was what you’d expect when praising a three year old’s finger painting.

Patients are also forced to assume child-like behaviours, such as being ‘allowed’ to walk once around the oval once a day, and lining up together four times a day for their medication. One night Julie sat in line for over two hours.

‘Patients were becoming anxious, crying and shaking because they were waiting in line so long and because their bodies where craving the medication they were expecting two hours ago.’

And it wasn’t just her artistic accomplishments that Julie was patronised about. Due to some error, Julie’s admission paperwork stated that she suffered anxiety. Yes, she was anxious when she arrived — who wouldn’t be anxious at the thought of spending a week in a mental hospital? — but she was not ‘suffering from anxiety’.

Nonetheless, every day, staff asked about her anxiety. When she clarified that she was not suffering from anxiety, they looked at her like she was delusional, as if she didn’t even know why she was there.

When Julie expressed frustration that she wasn’t being listened to she was told by a doctor that she was presenting as anxious and he suggested prescribing some medication for her anxiety disorder.

‘I quickly realised I had to monitor my body language and expression so I wouldn’t come across as manic or emotional, otherwise they would diagnose me with something else and try to prescribe more medication’, said Julie. ‘When you question authority you’re told that this behaviour is part of why you’re there. But whole point of being there was that I wanted to get off the drugs.’

This wasn’t the only case of over-prescribing. At night Julie wanted some medication to help her sleep — a not uncommon procedure in hospitals. But, rather than giving her valium or a sleeping tablet as she requested, she was told that she could only have Seroquel.

Seroquel is an antipsychotic drug used to treat schizophrenia, bipolar disorder, and recurrent major depressive disorder. It also turns you into a walking zombie, unable to focus, remember or have clear thoughts.

‘You do feel crazy when you are doped up on Seroquel and you can’t remember anything or can’t think clearly. You can’t focus when you’re on that sort of medication. All you can do is colour in. All these women are just sitting around colouring in mandalas.’

A big part of mental illness is losing your agency, feeling as though you have no control over your life. If you end up in a mental health facility then you are probably already doubting yourself.

But rather than working on strengthening these patients’ sense of self, this psychiatric hospital seemed to rob them of what little they had left.

‘The patients have no control over their lives.’ Julie said. ‘They have no idea how long they are going to be in hospital, the doctor only visits a couple of times a week and they have no idea when that will be. There doesn’t seem to be any one-to-one tailored sessions according to patient’s needs or progress and there is no emotional support. The staff seem to be suffering from compassion fatigue.’

With all the debates about mental health funding and the efforts to de-stigmatise mental health problems, we also need to focus on the type of care mental health patients are receiving.

If what I witnessed during my time visiting Julie over a week is any indication, then it’s likely that the ‘cure’ will be worse than the disease.

Kasey Edwards is the best-selling author of 4 books 30-Something and Over It, 30-Something and The Clock is Ticking, OMG! That's Not My Husband, and OMG! That's Not My Child.www.kaseyedwards.com

47 comments

It seems many aspects of life n the Ward haven't changed a great deal since my stint as a student social worker at Broughton Hall (Syd) In 1971. Until Psychiatrists, Ward Nurses etc adopt the view; "it could be me" this objectivisation of the patient(sic) can continue. At nearly $10k a week some reforms must be possible, yes - even in the kitchen. This article is an excellent and accurate portrayal of Ward life - unfortunately. It should not come as a surprise to anyone familar with the scene.Now let's switch to vaudeville and check into a public psychiatric ward ..

Commenter

Goolamingi

Location

Bega NSW

Date and time

February 28, 2013, 8:01AM

As a therapist, I find it very distressing to read this account, however I am not surprised, as part of my practice entails assisting clients to cease the medication (often overprescribed) which has exacerbated their problems. This involves titration, having a compounding pharmacist make up dosages which decrease by very small amounts, tailored to the client's tolerance levels. It is very effective and one which does not seem to be used as often as its efficacy would indicate.My philosophy has always been that I work with my clients to help them to find their own inner resources. Any process that infantilises and disempowers others has no place in mental health work. Whilst severe mental illness often requires medication for the safety of clients and others with whom they come in contact, the tendency to treat life-issues with medication is counterproductive. A whole-of-life approach is the only solution that works, in my experience.

Commenter

Cosmogony

Date and time

February 28, 2013, 8:37AM

Weaning people off medications , by gradual reduction of doses, is a common practice in the public system I have worked in.

Commenter

LeftyRoy

Location

Cydnee

Date and time

February 28, 2013, 9:17AM

So close, but so far. You touch on funding and then launch back into blaming the practitioners.

Do you really think that health care professionals want to abuse people? That psychiatrists spend 13+ years of study just to get the chance to over prescribe drugs? Or perhaps are they doing the best they can with an ever decreasing budget?

I’m sorry, but no matter how nice your friend is she isn’t qualified to medicate herself. Do you know her medical history in regards to valium? Do you know how valium interacts with her current prescriptions? Do you know how your friend behaves when the lights are out?

Try going there on the days when your friend is attempting suicide, or has broken off a chair leg and tries to stab people and it takes the strength of 5 men to be restrained. Mental health wards are over crowded and under staffed…if there was no reason for the people to be there they wouldn’t keep them there; they're not masochists.

Spend a day with a doctor next time too. Get the full story.

Commenter

Tom

Location

Canberra

Date and time

February 28, 2013, 8:38AM

"Do you really think that health care professionals want to abuse people? That psychiatrists spend 13+ years of study just to get the chance to over prescribe drugs?"

@Tom, the mental health care "professionals" that I've met seem to delight in wielding power over their patients, whom they consider inferior, and some disenchanted staff take out their frustrations on the patients. Someone very close to me spent time in a psychiatric ward, and was constantly bullied, ridiculed and belittled by your so-called "professionals" (and I was there to witness some of these incidents). Even though my friend is small, is not a violent person, and has never displayed any violent or aggressive tendencies, when she was reluctant to take her (over-prescribed) medication, she was set-upon by four large men and a nurse, and forced to submit to an injection. I witnessed that as well! When she finally was released, a couple of nurses told her "Oh, don't worry, you'll be back" (they were wrong, she never went back, or needed to go back) From what I've seen, abuse by so-called professionals in this field is more wide-spread than is commonly believed, and many actually seem to either enjoy it, or they simply don't care. If YOU need the full story, spend some time in a psych ward - as a patient..

Commenter

Muammar

Location

Melburbia

Date and time

February 28, 2013, 9:39AM

I was also a bit worried by aspects of this article. I used to work in a private psychiatric hospital and this article does not gel with my observations there.

Sorry, but "Julie" does not get to dictate whether she is given barbiturates such as Valium - which are highly addictive. I recall many patients who were upset at being given the "wrong" medication by their doctors. However, when I would liaise with the doctors seeking an explanation on their behalf, there was usually a very good one, such as potential drug interactions or potential for dependence. (By the way, Seroquel has plenty of applications outside psychosis and schizophrenia.)

Yes, nurses can sometimes be a bit patronising, but it sounds like the art therapist was trying to compliment Julie's work.

Far from Julie's experience, I found many people had to be repeatedly encouraged to discharge as they were often unwilling to go home ("back to all that") as soon as they were ready.

And the nurses asking about Julie's anxiety sound like they are exercising their duty of care by screening her daily for current symptoms. She wonders where is the tailored care? Well, maybe one example is the nurses reading her file and checking in with her.

To liken any Australian psych hospital today to "One Flew Over The Cuckoos Nest" is just damaging and dangerous beyond belief - it paints an unrealistic picture and is likely to discourage people from seeking the help they need.

Commenter

Red Pony

Date and time

February 28, 2013, 9:59AM

Hi Muammar - I’m not sure if anyone can win a war of anecdotal evidence but here goes. I’ve visited psychiatric wards since the 80’s. I count psychiatrists, psychologists and psych nurses amongst my friends and family. I count mentally ill people amongst my friends and family. I have heard all the stories both good and bad and I’ve come to the conclusion that mental health practitioners are just normal people; they have their flaws but they do the best they can.

Mental health has an awful stigma that affects both patients and practitioners and for some reason won’t go away. People try to explain away the symptoms of the patients to try and normalise them as not needing treatment; why must they be normal? People try and make out doctors to be bad because they control patients; why shouldn’t we try to control people who are a risk to themselves or others? Life isn’t as simple as you want it to be.

Commenter

Tom

Location

Canberra

Date and time

February 28, 2013, 10:14AM

Muammar,As someone who has worked in psych wards and had friends committed to them as well as work in them, I think I am qualified in saying that if your story is true it is far from being the norm... I've certainly never met a psychiatrist working in either of the wards I've worked at that "enjoyed" lording over patients. What I suspect you witnessed was a little gallows humour creeping in to some of the staff, something you might understand if you ever worked in a place like this; there is a genuine sense of fear at the unpredictability of the people in these places mixed with an inevitable (though generally mild) amused detachment from some of the more incredible things being claimed by people with the more severe disorders.

I have only seen a hand-full of patients ever "set-upon" by security and nurses in order to force "meds" (usually this means sedatives when such extreme action is taken however) and it's ALWAYS been because the patient has become violent and dangerous. The sad truth is that there are some truly broken and frightening people in psych wards that simply have to be treated this way for the sake of the safety of other patients and staff.

So please, try to be a little more balanced and understanding of both sides of the problem.

Commenter

David

Date and time

February 28, 2013, 10:53AM

@Tom, not trying to win anything, least of all a war. Granted, it's not an easy job, but then if it was easy, anyone could do it. These people need ot be sure that they can handle the pressure of working in that kind of environment, whilst treating their patients humanely and appropriately. If not, thye should not be there. I would certainly agree that the patients need treatment, especially those that are a risk to themselves or others - that is not in dispute. What concerns me is the lack of suitablility of many mental health professionals to their chosen profession, and the negative impact that their arrogance and incompetence can have on their patients.

Commenter

Muammar

Location

Melburbia

Date and time

February 28, 2013, 11:00AM

"What concerns me is the lack of suitablility of many mental health professionals to their chosen profession, and the negative impact that their arrogance and incompetence can have on their patients."

Well, that's a massive generalisation if ever I saw one. Where is your evidence that "many" health professionals are arrogant and incompetent? If you have specific concerns about the competence of a particular practitioner, you are free to report them to the AMA (doctors), the APS (psychologists) or the HCCC (all health care), who will investigate your complaint. Otherwise, you might want to consider the implications of publicly undermining confidence in an entire profession of (in my experience) dedicated and responsible practitioners.